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Wang W, Zhao Z, Tian X, Ma X, Xu L, Shang G. Noninvasive carbon dioxide monitoring in pediatric patients undergoing laparoscopic surgery: transcutaneous vs. end-tidal techniques. BMC Pediatr 2023; 23:20. [PMID: 36639787 PMCID: PMC9840246 DOI: 10.1186/s12887-023-03836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The present study aimed to investigate the correlation between transcutaneous carbon dioxide partial pressure (PtcCO2) and arterial carbon dioxide pressure (PaCO2) and the accuracy of PtcCO2 in predicting PaCO2 during laparoscopic surgery in pediatric patients. METHODS Children aged 2-8 years with American Society of Anesthesiologists (ASA) class I or II who underwent laparoscopic surgery under general anesthesia were selected. After anesthesia induction and tracheal intubation, PtcCO2 was monitored, and radial arterial catheterization was performed for continuous pressure measurement. PaCO2, PtcCO2, and end-tidal carbon dioxide partial pressure (PetCO2) were measured before pneumoperitoneum, and 30, 60, and 90 min after pneumoperitoneum, respectively. The correlation and agreement between PtcCO2 and PaCO2, PetCO2, and PaCO2 were evaluated. RESULTS A total of 32 patients were eventually enrolled in this study, resulting in 128 datasets. The linear regression equations were: PtcCO2 = 7.89 + 0.82 × PaCO2 (r2 = 0.70, P < 0.01); PetCO2 = 9.87 + 0.64 × PaCO2 (r2 = 0.69, P < 0.01). The 95% limits of agreement (LOA) of PtcCO2 - PaCO2 average was 0.66 ± 4.92 mmHg, and the 95% LOA of PetCO2 - PaCO2 average was -4.4 ± 4.86 mmHg. A difference of ≤ 5 mmHg was noted between PtcCO2 and PaCO2 in 122/128 samples and between PetCO2 and PaCO2 in 81/128 samples (P < 0.01). CONCLUSION In pediatric laparoscopic surgery, a close correlation was established between PtcCO2 and PaCO2. Compared to PetCO2, PtcCO2 can estimate PaCO2 accurately and could be used as an auxiliary monitoring indicator to optimize anesthesia management for laparoscopic surgery in children; however, it is not a substitute for PetCO2. REGISTRATION NUMBER OF CHINESE CLINICAL TRIAL REGISTRY ChiCTR2100043636.
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Affiliation(s)
- Weitao Wang
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Zhifa Zhao
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Xinjie Tian
- grid.452787.b0000 0004 1806 5224Department of Stomatology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Xinggang Ma
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, China Medical University, Shenzhen, China
| | - Liang Xu
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, Shenzhen, China
| | - Guanglin Shang
- grid.452787.b0000 0004 1806 5224Department of Anesthesiology, Shenzhen Children’s Hospital, Shenzhen, China
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A Patient-Ready Wearable Transcutaneous CO2 Sensor. BIOSENSORS 2022; 12:bios12050333. [PMID: 35624634 PMCID: PMC9138690 DOI: 10.3390/bios12050333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022]
Abstract
Continuously monitoring transcutaneous CO2 partial pressure is of crucial importance in the diagnosis and treatment of respiratory and cardiac diseases. Despite significant progress in the development of CO2 sensors, their implementation as portable or wearable devices for real-time monitoring remains under-explored. Here, we report on the creation of a wearable prototype device for transcutaneous CO2 monitoring based on quantifying the fluorescence of a highly breathable CO2-sensing film. The developed materials are based on a fluorescent pH indicator (8-hydroxy-1,3,6-pyrenetrisulfonic acid trisodium salt or HPTS) embedded into hydrophobic polymer matrices. The film’s fluorescence is highly sensitive to changes in CO2 partial pressure in the physiological range, as well as photostable and insensitive to humidity. The device and medical-grade films are based on our prior work on transcutaneous oxygen-sensing technology, which has been extensively validated clinically.
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Lee HJ, Chae JS, An SM, Oh HW, Kim YJ, Woo JH. Strategy to Reduce Hypercapnia in Robot-Assisted Radical Prostatectomy Using Transcutaneous Carbon Dioxide Monitoring: A Prospective Observational Study. Ther Clin Risk Manag 2022; 18:249-258. [PMID: 35330918 PMCID: PMC8938168 DOI: 10.2147/tcrm.s347690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Monitoring end-tidal carbon dioxide partial pressure (PETCO2) is a noninvasive, continuous method, but its accuracy is reduced by prolonged capnoperitoneum and the steep Trendelenburg position in robot-assisted radical prostatectomy (RARP). Transcutaneous carbon dioxide partial pressure (PTCCO2) monitoring, which is not affected by ventilator–perfusion mismatch, has been suggested as a suitable alternative. We compared the agreement of noninvasive measurements with the arterial carbon dioxide partial pressure (PaCO2) over a long period of capnoperitoneum, and investigated its sensitivity and predictive power for detecting hypercapnia. Patients and Methods The patients who underwent RARP were enrolled in this study prospectively. Intraoperative measurements of PETCO2, PTCCO2, and PaCO2 were analyzed. The primary outcome was the agreement of noninvasive monitoring with PaCO2 during prolonged capnoperitoneum. Bias and precision between noninvasive measurements and PaCO2 were assessed using Bland–Altman analysis. The bias and mean absolute difference were compared using a two-tailed Wilcoxon signed-rank test for pairs. The secondary outcome was the sensitivity and predictive power for detecting hypercapnia. To assess this, the Yates corrected chi-square test and the area under the receiver operating characteristic curve were used. Results The study analyzed 219 datasets from 46 patients. Compared with PETCO2, PTCCO2 had lower bias, greater precision, and better agreement with PaCO2 throughout the RARP. The mean absolute difference in PETCO2 and PaCO2 was larger than that of PTCCO2 and PaCO2, and continued to exceed the clinically acceptable range of 5 mmHg after 1 hour of capnoperitoneum. The sensitivity during capnoperitoneum and overall predictive power of PTCCO2 for detecting hypercapnia were significantly higher than those of PETCO2, suggesting a greater contribution to ventilator adjustment, to treat hypercapnia. Conclusion PTCCO2 monitoring measured PaCO2 more accurately than PETCO2 monitoring during RARP requiring prolonged capnoperitoneum and a steep Trendelenburg position. PTCCO2 monitoring also provides more sensitive measurements for ventilator adjustment and detects hypercapnia more effectively than PETCO2 monitoring.
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Affiliation(s)
- Hyun Jung Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Sang-Mee An
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Hye-Won Oh
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jae Hee Woo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
- Correspondence: Jae Hee Woo, Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, 260 Gonghangdaero, Gangseo-gu, Seoul, 07804, South Korea, Tel +82-2-6986-4300, Fax +82-2-6986-4960, Email
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Min SH, Yoon H, Huh G, Kwon SK, Seo JH, Cho YJ. Efficacy of high-flow nasal oxygenation compared with tracheal intubation for oxygenation during laryngeal microsurgery: a randomised non-inferiority study. Br J Anaesth 2021; 128:207-213. [PMID: 34688473 DOI: 10.1016/j.bja.2021.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Oxygenation via a high-flow nasal cannula (HFNC) can be an alternative to tracheal intubation during short apnoeic procedures. This randomised, non-inferiority study assessed the efficacy of HFNC compared with tracheal intubation in laryngeal microsurgery. METHODS Patients (≥20 yr old) undergoing laryngeal microsurgery under general anaesthesia and neuromuscular blockade were randomised to either the HFNC or tracheal intubation groups. The primary endpoint was lowest pulse oxygen saturation (SpO2) during the first 30 min of surgery. Secondary endpoints included incidence of desaturation (SpO2 <95%), hypercarbia (transcutaneous carbon dioxide [CO2] ≥8.7 kPa), and rescue intervention. RESULTS Amongst 130 patients randomised, 118 were included in the analysis. The lowest SpO2 was 100 (98-100)% in the HFNC group (n=56) and 100 (100-100)% in the tracheal intubation group (n=62), with a mean difference of -1.4% (95% confidence interval: -2.4% and -0.3%), failing to confirm non-inferiority with a non-inferiority margin of 2%. The peak transcutaneous CO2 and end-tidal CO2 at the end of surgery were higher in the HFNC group compared with the tracheal intubation group. Incidences of desaturation, hypercarbia, and rescue intervention were more frequent in patients receiving HFNC compared with tracheal intubation. CONCLUSIONS HFNC oxygenation was not non-inferior to tracheal intubation for maintaining oxygen saturation during laryngeal microsurgery. Considering more frequent desaturation, hypercarbia, and requirement for rescue intervention compared with tracheal intubation, HFNC should be used with cautious monitoring even for short duration airway surgery. CLINICAL TRIAL REGISTRATION NCT03629353.
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Affiliation(s)
- Se-Hee Min
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Heechul Yoon
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong K Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwa Seo
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn J Cho
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Contini M, Angelucci A, Aliverti A, Gugliandolo P, Pezzuto B, Berna G, Romani S, Tedesco CC, Agostoni P. Comparison between PtCO 2 and PaCO 2 and Derived Parameters in Heart Failure Patients during Exercise: A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2021; 21:6666. [PMID: 34640985 PMCID: PMC8512849 DOI: 10.3390/s21196666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/13/2022]
Abstract
Evaluation of arterial carbon dioxide pressure (PaCO2) and dead space to tidal volume ratio (VD/VT) during exercise is important for the identification of exercise limitation causes in heart failure (HF). However, repeated sampling of arterial or arterialized ear lobe capillary blood may be clumsy. The aim of our study was to estimate PaCO2 by means of a non-invasive technique, transcutaneous PCO2 (PtCO2), and to verify the correlation between PtCO2 and PaCO2 and between their derived parameters, such as VD/VT, during exercise in HF patients. 29 cardiopulmonary exercise tests (CPET) performed on a bike with a ramp protocol aimed at achieving maximal effort in ≈10 min were analyzed. PaCO2 and PtCO2 values were collected at rest and every 2 min during active pedaling. The uncertainty of PCO2 and VD/VT measurements were determined by analyzing the error between the two methods. The accuracy of PtCO2 measurements vs. PaCO2 decreases towards the end of exercise. Therefore, a correction to PtCO2 that keeps into account the time of the measurement was implemented with a multiple regression model. PtCO2 and VD/VT changes at 6, 8 and 10 min vs. 2 min data were evaluated before and after PtCO2 correction. PtCO2 overestimates PaCO2 for high timestamps (median error 2.45, IQR -0.635-5.405, at 10 min vs. 2 min, p-value = 0.011), while the error is negligible after correction (median error 0.50, IQR = -2.21-3.19, p-value > 0.05). The correction allows removing differences also in PCO2 and VD/VT changes. In HF patients PtCO2 is a reliable PaCO2 estimation at rest and at low exercise intensity. At high exercise intensity the overall response appears delayed but reproducible and the error can be overcome by mathematical modeling allowing an accurate estimation by PtCO2 of PaCO2 and VD/VT.
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Affiliation(s)
- Mauro Contini
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
| | - Alessandra Angelucci
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy;
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy;
| | - Paola Gugliandolo
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
| | - Beatrice Pezzuto
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
| | - Giovanni Berna
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
| | - Simona Romani
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
| | - Calogero Claudio Tedesco
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy; (M.C.); (P.G.); (B.P.); (G.B.); (S.R.); (C.C.T.); (P.A.)
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, 20122 Milan, Italy
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Rafl J, Kulhanek F, Kudrna P, Ort V, Roubik K. Response time of indirectly accessed gas exchange depends on measurement method. BIOMED ENG-BIOMED TE 2018; 63:647-655. [PMID: 28802098 DOI: 10.1515/bmt-2017-0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 07/03/2017] [Indexed: 11/15/2022]
Abstract
Noninvasive techniques are routinely used for assessment of tissue effects of lung ventilation. However, comprehensive studies of the response time of the methods are scarce. The aim of this study was to compare the response time of noninvasive methods for monitoring of gas exchange to sudden changes in the composition of the inspired gas. A prospective experimental study with 16 healthy volunteers was conducted. A ventilation circuit was designed that enabled a fast change in the composition of the inspiratory gas mixture while allowing spontaneous breathing. The volunteers inhaled a hypoxic mixture, then a hypercapnic mixture, a hyperoxic mixture and finally a 0.3% CO mixture. The parameters with the fastest response to the sudden change of O2 in inhaled gas were peripheral capillary oxygen saturation (SpO2) and regional tissue oxygenation (rSO2). Transcutaneous oxygen partial pressure (tcpO2) had almost the same time of reaction, but its time of relaxation was 2-3 times longer. End-tidal carbon dioxide (EtCO2) response time to change of CO2 concentration in inhaled gas was less than half in comparison with transcutaneous carbon dioxide partial pressure (tcpCO2). All the examined parameters and devices reacted adequately to changes in gas concentration in the inspiratory gas mixture.
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Affiliation(s)
- Jakub Rafl
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Technology, nam. Sitna 3105, 272 01 Kladno, Czech Republic, Phone: +420 728 229 991, Fax: +420 224 358 419
| | - Filip Kulhanek
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Technology, 272 01 Kladno, Czech Republic
| | - Petr Kudrna
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Technology, 272 01 Kladno, Czech Republic
| | - Vaclav Ort
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Technology, 272 01 Kladno, Czech Republic
| | - Karel Roubik
- Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Technology, 272 01 Kladno, Czech Republic
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Tomasic I, Tomasic N, Trobec R, Krpan M, Kelava T. Continuous remote monitoring of COPD patients-justification and explanation of the requirements and a survey of the available technologies. Med Biol Eng Comput 2018; 56:547-569. [PMID: 29504070 PMCID: PMC5857273 DOI: 10.1007/s11517-018-1798-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/30/2018] [Indexed: 01/03/2023]
Abstract
Remote patient monitoring should reduce mortality rates, improve care, and reduce costs. We present an overview of the available technologies for the remote monitoring of chronic obstructive pulmonary disease (COPD) patients, together with the most important medical information regarding COPD in a language that is adapted for engineers. Our aim is to bridge the gap between the technical and medical worlds and to facilitate and motivate future research in the field. We also present a justification, motivation, and explanation of how to monitor the most important parameters for COPD patients, together with pointers for the challenges that remain. Additionally, we propose and justify the importance of electrocardiograms (ECGs) and the arterial carbon dioxide partial pressure (PaCO2) as two crucial physiological parameters that have not been used so far to any great extent in the monitoring of COPD patients. We cover four possibilities for the remote monitoring of COPD patients: continuous monitoring during normal daily activities for the prediction and early detection of exacerbations and life-threatening events, monitoring during the home treatment of mild exacerbations, monitoring oxygen therapy applications, and monitoring exercise. We also present and discuss the current approaches to decision support at remote locations and list the normal and pathological values/ranges for all the relevant physiological parameters. The paper concludes with our insights into the future developments and remaining challenges for improvements to continuous remote monitoring systems. Graphical abstract ᅟ.
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Affiliation(s)
- Ivan Tomasic
- Division of Intelligent Future Technologies, Mälardalen University, Högskoleplan 1, 72123, Västerås, Sweden.
| | - Nikica Tomasic
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Roman Trobec
- Department of Communication Systems, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Miroslav Krpan
- Department of Cardiology, University Hospital Centre, Zagreb, Croatia
| | - Tomislav Kelava
- Department of Physiology, School of Medicine, University of Zagreb, Zagreb, Croatia
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Sleep Transcutaneous vs. End-Tidal CO2 Monitoring for Patients with Neuromuscular Disease. Am J Phys Med Rehabil 2016; 95:91-5. [DOI: 10.1097/phm.0000000000000345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Response to Noninvasive Pco2 Monitoring During Sleep for Patients with Neuromuscular Disease. Am J Phys Med Rehabil 2016; 95:e39-40. [PMID: 26745219 DOI: 10.1097/phm.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Choi SH, Kim JY, Yoon YH, Park SJ, Moon SW, Cho YD. The use of transcutaneous CO2 monitoring in cardiac arrest patients: a feasibility study. Scand J Trauma Resusc Emerg Med 2014; 22:70. [PMID: 25471936 PMCID: PMC4256748 DOI: 10.1186/s13049-014-0070-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/11/2014] [Indexed: 11/11/2022] Open
Abstract
Background Prediction of the return of spontaneous circulation (ROSC) in cardiac arrest patients is a parameter for deciding when to stop cardiopulmonary resuscitation (CPR) or to start extracorporeal CPR. We investigated the change in transcutaneous PCO2 (PtcCO2) in cardiac arrest patients. Methods This study was carried out as a retrospective chart review. Patients with out-of-hospital cardiac arrest or in-hospital cardiac arrest within the emergency department were included. PtcCO2 monitoring with a V-Sign™ combined monitor (SenTec Inc., Therwil, Switzerland) was applied to patients at the start of CPR. We divided the included patients into the ROSC group and the no ROSC group. The ROSC group was subdivided into those achieving ROSC <15 min CPR and >15 min CPR. The change in the PtcCO2 value was analyzed at 0 min, 5 min, 10 min, and 15 min from PtcCO2 stabilization and was compared among the groups. Results A total of 42 patients were enrolled. Twenty-eight patients achieved ROSC; 13 patients achieved ROSC <15 min CPR and 15 patients achieved ROSC >15 min CPR. Fourteen patients expired without ROSC. The absolute values of PtcCO2 was lower in the ROSC group than in the no ROCS group. The PtcCO2 change over time had a tendency to decrease or to remain constant in the ROSC groups. In contrast, all patients in the no ROSC group experienced an increase in the PtcCO2 change during CPR except one case. Conclusions PtcCO2 monitoring provides non-invasive, continuous, and useful monitoring in cardiac arrest patients.
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Affiliation(s)
| | | | - Young-Hoon Yoon
- Department of Emergency Medicine, Korea University College of Medicine, 73, Inchon-ro, Sungbuk-gu, Seoul, South Korea.
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Holowaychuk MK, Fujita H, Bersenas AME. Evaluation of a transcutaneous blood gas monitoring system in critically ill dogs. J Vet Emerg Crit Care (San Antonio) 2014; 24:545-53. [PMID: 25186166 DOI: 10.1111/vec.12216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the use of a transcutaneous blood gas monitoring system in critically ill dogs, determine if transcutaneous and arterial blood gas values have good agreement, and verify if clinical or laboratory variables are correlated with differences between transcutaneous and arterial blood gas measurements. DESIGN Prospective observational study. SETTING University teaching hospital ICU. ANIMALS Twenty-three client-owned dogs. INTERVENTIONS In critically ill dogs undergoing arterial blood gas monitoring, a transcutaneous blood gas monitor was used to measure transcutaneous partial pressure of carbon dioxide (PtcCO2 ) and transcutaneous partial pressure of oxygen (PtcO2 ) values 30 minutes after sensor placement, which were compared to PaCO2 and PaO2 values measured simultaneously. Clinical and laboratory variables were concurrently recorded to determine if they were correlated with the difference between transcutaneous and arterial blood gas measurements. MEASUREMENTS AND MAIN RESULTS Bland-Altman analysis revealed a mean bias of 4.6 ± 26.3 mm Hg (limits of agreement [LOA]: -46.9/+56.1 mm Hg) between PtcO2 and PaO2 and a mean bias of 9.3 ± 8.5 mm Hg (LOA: -7.5/+26.0 mm Hg) between PtcCO2 and PaCO2 . The difference between PtcCO2 -PaCO2 was strongly negatively correlated with HCO3 (-) (r(2) = 0.52, P < 0.001) and PaCO2 (r(2) = 0.58, P < 0.001) and weakly positively correlated with diastolic blood pressure (r(2) = 0.21, P = 0.044), whereas the difference between PtcCO2 -PaCO2 was moderately negatively correlated with diastolic blood pressure (r(2) = 0.33, P = 0.008). CONCLUSIONS Agreement between transcutaneous and arterial PO2 and PCO2 measurements in these critically ill dogs was inferior to that reported in similar adult and pediatric human studies. The transcutaneous monitor consistently over-estimated PaO2 and PaCO2 and should not be used to replace arterial blood gas measurements in critically ill dogs requiring blood gas interpretation.
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Affiliation(s)
- Marie K Holowaychuk
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
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Liu S, Sun J, Chen X, Yu Y, Liu X, Liu C. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery. PLoS One 2014; 9:e91563. [PMID: 24699267 PMCID: PMC3974655 DOI: 10.1371/journal.pone.0091563] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/12/2014] [Indexed: 11/18/2022] Open
Abstract
To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, P<0.01), whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2) = 0.89). The LOA (limits of agreement) of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD), while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD). In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.
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Affiliation(s)
- Shijiang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Sun
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xing Chen
- Department of Project Management, Jiangsu New Energy Development Company, Jiangsu Guoxin Investment Group, Nanjing, China
| | - Yingying Yu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Liu
- Department of Anesthesiology, General Hospital of TISCO, TaiYuan, China
| | - Cunming Liu
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail:
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Buehler S, Jensen MC, Lozano-Zahonero S, Gottlieb D, Eckle D, Szczyrba M, Schumann S, Moeller K, Guttmann J. The dynamics of carbon dioxide equilibration after alterations in the respiratory rate. Physiol Meas 2013; 34:1151-61. [DOI: 10.1088/0967-3334/34/9/1151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Esquinas AM, Lo Coco D. Non-invasive mechanical ventilation and transcutaneous carbon dioxide monitoring in amyotrophic lateral sclerosis: The silent watchdog. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:152-3. [DOI: 10.3109/21678421.2012.760607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012; 8:597-619. [PMID: 23066376 DOI: 10.5664/jcsm.2172] [Citation(s) in RCA: 3288] [Impact Index Per Article: 274.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Academy of Sleep Medicine (AASM) Sleep Apnea Definitions Task Force reviewed the current rules for scoring respiratory events in the 2007 AASM Manual for the Scoring and Sleep and Associated Events to determine if revision was indicated. The goals of the task force were (1) to clarify and simplify the current scoring rules, (2) to review evidence for new monitoring technologies relevant to the scoring rules, and (3) to strive for greater concordance between adult and pediatric rules. The task force reviewed the evidence cited by the AASM systematic review of the reliability and validity of scoring respiratory events published in 2007 and relevant studies that have appeared in the literature since that publication. Given the limitations of the published evidence, a consensus process was used to formulate the majority of the task force recommendations concerning revisions.The task force made recommendations concerning recommended and alternative sensors for the detection of apnea and hypopnea to be used during diagnostic and positive airway pressure (PAP) titration polysomnography. An alternative sensor is used if the recommended sensor fails or the signal is inaccurate. The PAP device flow signal is the recommended sensor for the detection of apnea, hypopnea, and respiratory effort related arousals (RERAs) during PAP titration studies. Appropriate filter settings for recording (display) of the nasal pressure signal to facilitate visualization of inspiratory flattening are also specified. The respiratory inductance plethysmography (RIP) signals to be used as alternative sensors for apnea and hypopnea detection are specified. The task force reached consensus on use of the same sensors for adult and pediatric patients except for the following: (1) the end-tidal PCO(2) signal can be used as an alternative sensor for apnea detection in children only, and (2) polyvinylidene fluoride (PVDF) belts can be used to monitor respiratory effort (thoracoabdominal belts) and as an alternative sensor for detection of apnea and hypopnea (PVDFsum) only in adults.The task force recommends the following changes to the 2007 respiratory scoring rules. Apnea in adults is scored when there is a drop in the peak signal excursion by ≥ 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative apnea sensor, for ≥ 10 seconds. Hypopnea in adults is scored when the peak signal excursions drop by ≥ 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for ≥ 10 seconds in association with either ≥ 3% arterial oxygen desaturation or an arousal. Scoring a hypopnea as either obstructive or central is now listed as optional, and the recommended scoring rules are presented. In children an apnea is scored when peak signal excursions drop by ≥ 90% of pre-event baseline using an oronasal thermal sensor (diagnostic study), PAP device flow (titration study), or an alternative sensor; and the event meets duration and respiratory effort criteria for an obstructive, mixed, or central apnea. A central apnea is scored in children when the event meets criteria for an apnea, there is an absence of inspiratory effort throughout the event, and at least one of the following is met: (1) the event is ≥ 20 seconds in duration, (2) the event is associated with an arousal or ≥ 3% oxygen desaturation, (3) (infants under 1 year of age only) the event is associated with a decrease in heart rate to less than 50 beats per minute for at least 5 seconds or less than 60 beats per minute for 15 seconds. A hypopnea is scored in children when the peak signal excursions drop is ≥ 30% of pre-event baseline using nasal pressure (diagnostic study), PAP device flow (titration study), or an alternative sensor, for ≥ the duration of 2 breaths in association with either ≥ 3% oxygen desaturation or an arousal. In children and adults, surrogates of the arterial PCO(2) are the end-tidal PCO(2) or transcutaneous PCO(2) (diagnostic study) or transcutaneous PCO(2) (titration study). For adults, sleep hypoventilation is scored when the arterial PCO(2) (or surrogate) is > 55 mm Hg for ≥ 10 minutes or there is an increase in the arterial PCO(2) (or surrogate) ≥ 10 mm Hg (in comparison to an awake supine value) to a value exceeding 50 mm Hg for ≥ 10 minutes. For pediatric patients hypoventilation is scored when the arterial PCO(2) (or surrogate) is > 50 mm Hg for > 25% of total sleep time. In adults Cheyne-Stokes breathing is scored when both of the following are met: (1) there are episodes of ≥ 3 consecutive central apneas and/or central hypopneas separated by a crescendo and decrescendo change in breathing amplitude with a cycle length of at least 40 seconds (typically 45 to 90 seconds), and (2) there are five or more central apneas and/or central hypopneas per hour associated with the crescendo/decrescendo breathing pattern recorded over a minimum of 2 hours of monitoring.
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Affiliation(s)
- Richard B Berry
- University of Florida Health Science Center, Gainesville, FL 32610, USA.
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Razi E, Moosavi GA, Omidi K, Khakpour Saebi A, Razi A. Correlation of end-tidal carbon dioxide with arterial carbon dioxide in mechanically ventilated patients. ARCHIVES OF TRAUMA RESEARCH 2012; 1:58-62. [PMID: 24396744 PMCID: PMC3876523 DOI: 10.5812/atr.6444] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/25/2012] [Accepted: 06/30/2012] [Indexed: 01/16/2023]
Abstract
Background: Patients undergone mechanical ventilation need rapid and reliable evaluation of their respiratory status. Monitoring of End-tidal carbon dioxide (ETCO2) as a surrogate, noninvasive measurement of arterial carbon dioxide (PaCO2) is one of the methods used for this purpose in intubated patients. Objectives: The aim of the present trial was to study the relationship between end-tidal CO2 tensions with PaCO2 measurements in mechanically ventilated patients. Materials and Methods: End-tidal carbon dioxide levels were recorded at the time of arterial blood gas sampling. Patients who were undergoing one of the mechanical ventilation methods such as: synchronized mandatory mechanical ventilation (SIMV), continuous positive airway pressure (CPAP) and T-Tube were enrolled in this study. The difference between ETCO2 and PaCO2 was tested with a paired t-test. The correlation of end-tidal carbon dioxide to (ETCO2) CO2 was obtained in all patients. Results: A total of 219 arterial blood gases were obtained from 87 patients (mean age, 71.7 ± 15.1 years). Statistical analysis demonstrated a good correlation between the mean of ETCO2 and PaCO2 in each of the modes of SIMV, CPAP and T-Tube; SIMV (42.5 ± 17.3 and 45.8 ± 17.1; r = 0.893, P < 0.0001), CPAP (37 ± 9.7 and 39.4 ± 10.1; r = 0.841, P < 0.0001) and T-Tube (36.1 ± 9.9 and 39.4 ± 11; r = 0.923, P < 0.0001), respectively. Conclusions: End-tidal CO2 measurement provides an accurate estimation of PaCO2 in mechanically ventilated patients. Its use may reduce the need for invasive monitoring and/or repeated arterial blood gas analyses.
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Affiliation(s)
- Ebrahim Razi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | | | - Keivan Omidi
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | | | - Armin Razi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Armin Razi, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel.: +98-9122276553, Fax: +98-3615550089. E-mail:
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Gancel PE, Masson R, Du Cheyron D, Roupie E, Lofaso F, Terzi N. PCO2 transcutanée: pourquoi, comment et pour qui ? MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0450-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhang P, Huang G, Shi X. Cerebral vasoreactivity during hypercapnia is reset by augmented sympathetic influence. J Appl Physiol (1985) 2010; 110:352-8. [PMID: 21071587 DOI: 10.1152/japplphysiol.00802.2010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sympathetic nerve activity influences cerebral blood flow, but it is unknown whether augmented sympathetic nerve activity resets cerebral vasoreactivity to hypercapnia. This study tested the hypothesis that cerebral vasodilation during hypercapnia is restrained by lower-body negative pressure (LBNP)-stimulated sympathoexcitation. Cerebral hemodynamic responses were assessed in nine healthy volunteers [age 25 yr (SD 3)] during rebreathing-induced increases in partial pressure of end-tidal CO(2) (Pet(CO(2))) at rest and during LBNP. Cerebral hemodynamic responses were determined by changes in flow velocity of middle cerebral artery (MCAV) using transcranial Doppler sonography and in regional cerebral tissue oxygenation (ScO(2)) using near-infrared spectroscopy. Pet(CO(2)) values during rebreathing were similarly increased from 41.9 to 56.5 mmHg at rest and from 40.7 to 56.0 mmHg during LBNP of -15 Torr. However, the rates of increases in MCAV and in ScO(2) per unit increase in Pet(CO(2)) (i.e., the slopes of MCAV/Pet(CO(2)) and ScO(2)/Pet(CO(2))) were significantly (P ≤0.05) decreased from 2.62 ± 0.16 cm·s(-1)·mmHg(-1) and 0.89 ± 0.10%/mmHg at rest to 1.68 ± 0.18 cm·s(-1)·mmHg(-1) and 0.63 ± 0.07%/mmHg during LBNP. In conclusion, the sensitivity of cerebral vasoreactivity to hypercapnia, in terms of the rate of increases in MCAV and in ScO(2), is diminished by LBNP-stimulated sympathoexcitation.
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Affiliation(s)
- Peizhen Zhang
- Department of Integrative Physiology, UNT Health Science Center, Fort Worth, TX 76107, USA
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Storre JH, Magnet FS, Dreher M, Windisch W. Transcutaneous monitoring as a replacement for arterial PCO(2) monitoring during nocturnal non-invasive ventilation. Respir Med 2010; 105:143-50. [PMID: 21030230 DOI: 10.1016/j.rmed.2010.10.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 10/04/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Continuous, non-invasive assessment of alveolar ventilation achieved by transcutaneous PCO(2) (PtcCO(2)) monitoring is clearly superior to intermittent, invasive blood gas analyses in patients receiving nocturnal non-invasive positive pressure ventilation (NPPV), but the reliability and accuracy of PtcCO(2)-monitoring is still disputed. The present study was aimed at investigating the capability of modern PtcCO(2)-monitoring to reliably assess alveolar ventilation during nocturnal NPPV. METHODS Capillary blood gas measurements (11pm, 2am, 5am and 7am) and 8 h of continuous PtcCO(2)-monitoring using three of the latest generation devices (SenTec Digital Monitor, Radiometer TCM4-TINA and Radiometer TOSCA500) were performed during polysomnography-proven sleep studies in 24 patients receiving NPPV (15 with COPD, 9 with restrictive disorders). RESULTS The technical calibration drift for SenTec DM, TCM4-TINA and TOSCA500 was 0.1, -0.4 and -0.5 mmHg/h, respectively. Bland-Altman method comparison of PaCO(2)/drift-uncorrected PtcCO(2) revealed a mean bias (limits of agreement) of 1.0 (-4.7 to 6.7), -1.5 (-15.6 to 12.5) and 0.8 (-6.8 to 8.3) mmHg, respectively. Continuous overnight PtcCO(2)-monitoring detected variations in alveolar ventilation, with median ranges of 12.3 (10.7-14.5) mmHg for SenTec DM, 14.5 (12.5-17.0) mmHg for TCM4-TINA and 11.5 (11.0-13.0) mmHg for TOSCA500 (RM-ANOVA, p < 0.001). The four capillary PaCO(2) values ranged by a median of 6.3 (4.7-9.7) mmHg. CONCLUSIONS Modern PtcCO(2)-monitoring is reliable, accurate and robust. Since PtcCO(2)-monitoring is also non-invasive, does not disrupt sleep quality and provides a more complete picture of alveolar ventilation than intermittent capillary PaCO(2), PtcCO(2)-monitoring should become the preferred technique for assessing alveolar ventilation during nocturnal NPPV. TRIAL REGISTRATION DRKS00000433 at http://apps.who.int/trialsearch/default.aspx.
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Affiliation(s)
- Jan Hendrik Storre
- Department of Pneumology, University Hospital Freiburg, Killianstrasse 5, D-79106 Freiburg, Germany.
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Transcutaneous carbon dioxide monitoring accurately predicts arterial carbon dioxide partial pressure in patients undergoing prolonged laparoscopic surgery. Anesth Analg 2010; 111:417-20. [PMID: 20584872 DOI: 10.1213/ane.0b013e3181e30b54] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There may be large differences between measurements of end-tidal carbon dioxide partial pressure (Petco(2)) and arterial carbon dioxide partial pressure (Paco(2)) during laparoscopic surgeries. Transcutaneous carbon dioxide (Ptcco(2)) monitoring can be used to noninvasively and continuously estimate Paco(2). In the present study we evaluated the accuracy of Ptcco(2) monitoring in predicting the Paco(2) during laparoscopic surgeries with prolonged pneumoperitoneum. METHODS Sixteen patients who underwent laparoscopic radical gastrectomy or radical proctectomy under general anesthesia were included in the study. Their Paco(2), Petco(2), and Ptcco(2) values were measured at 3 time points before and after pneumoperitoneum. Agreement among measures was assessed by the Bland-Altman method. RESULTS Forty-eight sample sets were obtained. The average Paco(2)- Ptcco(2) difference was -0.9 + or - 6.4 mm Hg (mean + or - 2 SD). The average Paco(2) - Petco(2) difference was 7.5 + or - 7.0 mm Hg (mean + or - 2 SD). Paco(2) - Ptcco(2) was less than or equal to + or -5 mm Hg for 88% of the samples. Paco(2) - Petco(2) was less than or equal to + or -5 mm Hg for 17% of the samples (P < 0.05). CONCLUSIONS While undergoing long-term pneumoperitoneum laparoscopic surgery, Ptcco(2) monitoring is more accurate than is PETCO(2) monitoring in predicting the patients' Paco(2).
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Aittokallio T, Virkki A, Polo O. Understanding sleep-disordered breathing through mathematical modelling. Sleep Med Rev 2009; 13:333-43. [DOI: 10.1016/j.smrv.2008.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 09/30/2008] [Accepted: 09/30/2008] [Indexed: 11/17/2022]
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Hirabayashi M, Fujiwara C, Ohtani N, Kagawa S, Kamide M. Transcutaneous PCO2 monitors are more accurate than end-tidal PCO2 monitors. J Anesth 2009; 23:198-202. [PMID: 19444557 DOI: 10.1007/s00540-008-0734-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 12/12/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE The accuracy of monitors for measuring transcutaneous PCO2 (TcPCO2), end-tidal PCO2 (EtPCO2), and nasal EtPCO2 was evaluated. METHODS The measuring devices included a TcPCO2 monitor (TCM3; Radiometer Trading), an EtPCO2 monitor (Ultima; Datex-Ohmeda), and a nasal EtPCO2 monitor (TG-920P; Nihon Kohden). The sensor electrode of the TCM3 TcPCO2 monitor was applied to the skin of the subject's upper arm. A sampling tube attached to the proximal end of the tracheal tube was connected to the Ultima EtPCO2 monitor. The miniature sensor of the TG-920P nasal EtPCO2 monitor was attached to the nostril. The values obtained were compared with direct measurements of arterial PCO2 (PaCO2) obtained by means of an ABL700 blood gas analyzer (Radiometer Trading) in surgically treated patients. The means +/- 2 SD of the differences between variables were calculated. RESULTS The TcPCO2 monitor (0.19 +/- 4.8 mmHg, mean +/- 2-SD) was more accurate than the EtPCO2 monitor (-4.4 +/- 6.5 mmHg, mean +/- 2-SD) in patients receiving artificial ventilation via an endotracheal tube and the TcPCO2 monitor was also more accurate than the nasal EtPCO2 monitor (-6.3 +/- 9.8 mmHg, bias +/- 2-SD) in patients breathing spontaneously. CONCLUSION We found that the TcPCO2 monitor was more accurate than the EtPCO2 or nasal EtPCO2 monitor in surgically treated patients.
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Affiliation(s)
- Makihiko Hirabayashi
- Department of Anesthesiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Abstract
There is no need to reinvent the wheel to determine the need for vigilant monitoring in outside of the operating room (OOR) settings. Anesthesiologists have evolved a robust system of monitoring standards based on decades of experience in operating room environments. Every OOR location should be thoroughly evaluated and monitoring standards implemented. The standards should be periodically reviewed to avert morbidity.
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Affiliation(s)
- Samuel M Galvagno
- Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Aittokallio J, Polo O, Hiissa J, Virkki A, Toikka J, Raitakari O, Saaresranta T, Aittokallio T. Overnight variability in transcutaneous carbon dioxide predicts vascular impairment in women. Exp Physiol 2008; 93:880-91. [DOI: 10.1113/expphysiol.2007.041277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Eberhard P. The design, use, and results of transcutaneous carbon dioxide analysis: current and future directions. Anesth Analg 2007; 105:S48-S52. [PMID: 18048898 DOI: 10.1213/01.ane.0000278642.16117.f8] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Transcutaneous carbon dioxide (CO2) analysis was introduced in the early 1980s using locally heated electrochemical sensors that were applied to the skin surface. This methodology provides a continuous noninvasive estimation of the arterial CO2 value and can be used for assessing adequacy of ventilation. The technique is now established and used routinely in clinical practice. Transcutaneous partial pressure of CO2 (tcPco2) sensors are available as a single Pco2 sensor, as a combined Pco2/Po2 sensor, and more recently, as a combined Pco2/Spo2 sensor. CO2 is still measured potentiometrically by determining the pH of an electrolyte layer. The methodology has been continuously developed during the last 20 yr, making the tcPco2 systems easier and more reliable for use in clinical practice: smaller sensor size (diameter 15 mm, height 8 mm), less frequent sensor re-membraning (every 2 wk) and calibration (twice a day), sensor ready to use when connected to the monitor, lower sensor temperature (42 degrees C), shorter arterialization time (3 min), and increased measurement reliability through protection of the membrane. The present tcPco2 sensors still need to be regularly re-membraned and calibrated. One way to overcome these procedures is to use optical-only detection means. Two techniques have been developed using optical absorption in the near-infrared light, in the evanescent wave of a waveguide integrated in the sensor surface, or in a micro-optics sampling cell. Preliminary in vitro and in vivo CO2 measurements have been performed. The sensor is not affected by drift over several days, and its response time is <1 min.
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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